Focal intrahepatic strictures: A proposal classification based on diagnosis-treatment experience and systemic review

Table 2 Imaging and endoscopic diagnosis of focal intrahepatic strictures

No.	Method of examination	Characteristics of FIHS lesion						Characteristics of secondary changes
		Location of FIHS	Enhancement of FIHS lesion in different phases				Imaging diagnosis	Hepatatrophia	Intrahepatic bile duct dilation	Hepatolithiasis
			Plain	Arterial	Portal	Delayed
1	MDCT	Not clear	-	-	faint	faint	Left hepatic lobe atrophy, LIHD dilation, Suspected ICC	+	B2, B3	-
2	MDCT	Confluence of B2/B3	-	+	-	-	rHCC with BDTT/PVTT	-	B2, B3	-
	MRCP		-	+	-	-		-	B2, B3	-
3	MDCT	Confluence of B2/B3/B4	-	-	-	-	Hepatolithiasis, Suspected ICC	-	B2, B3, B4	+
	MRCP		-	-	-	-		-	B2, B3, B4	+
4	US	Not clear	N/A	N/A	N/A	N/A	High-echo lesion in S4	-	LIHD	-
	MDCT	Not clear	-	-	-	-	LIHD dilation	-	LIHD	-
	MRCP	Not clear	-	-	-	-	High T2 signal in S4LIHD dilation, Suspected ICC	-	LIHD	-
	ERCP+Spyglass	Not clear	N/A	N/A	N/A	N/A	Acute cholangitis	N/A	Not clear	-
	IOUS, Choledochoscopy	Confluence of B2/B3/B4	N/A	N/A	N/A	N/A	Acute cholangitis, Hepatolithiasis	-	B2, B3, B4	+
5	MRCP	Multiple small IHD	-	-	-	-	Hepatitis	-	-	-
6	MDCT	Multiple small IHD	-	-	-	-	Acute cholangitis	-	-	-
	MRCP		-	-	-	-	Acute cholangitis, Suspected PSC	-	-	-
	ERCP		N/A	N/A	N/A	N/A	PSC	N/A	-	-

FIHS: Focal intrahepatic strictures; MDCT: Multidetector-row computed tomography; LIHD: Left intrahepatic duct; ICC: Intrahepatic cholangiocarcinoma; B2: Bile duct of segment II; B3: Bile duct of segment III; B4: Bile duct of segment IV; S4: Segment IV; MRCP: Magnetic resonance cholangiopancreatography; US: Ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography; IOUS: Intraoperative ultrasonography; BDTT: Bile duct tumor thrombi; PVTT: Portal vein tumor thrombus; rHCC: Recurrent hepatocellular carcinoma; PSC: Primary sclerosing cholangitis; N/A: Not applicable.